Healthcare Provider Details

I. General information

NPI: 1699080200
Provider Name (Legal Business Name): TINA HEPWORTH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N NAPPANEE ST STE 4A
ELKHART IN
46514-1502
US

IV. Provider business mailing address

500 N NAPPANEE ST STE 4A
ELKHART IN
46514-1502
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-8992
  • Fax: 574-246-0171
Mailing address:
  • Phone: 574-522-8992
  • Fax: 574-246-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: